DOACs versus Warfarin for VTE in Obese Patients

A study found that use of direct oral anticoagulants (DOACs) significantly decreased recurrent venous thromboembolism (VTE) or major bleeding compared with warfarin in obese patients. The results of the study were presented by Kristin Brower, PharmD, BCPS, specialty practice pharmacist at The James Cancer Hospital at The Ohio State University Wexner Medical Center, at HOPA’s 16th Annual Conference.

The retrospective cohort study included 77 obese patients aged 18 to 89 years who were treated for VTE with a DOAC (apixaban or rivaroxaban; n=31) or warfarin (n=46) between December 2010 and July 31, 2017. Patients who received thrombectomy or a thrombolytic, received concurrent dual antiplatelet therapy, had an indication for anticoagulation other than VTE, had absence of two or more documented follow-up encounters, and had a platelet count <50,000 μL-1 were excluded.

Most patients (71%) in the DOAC group received rivaroxaban. In the warfarin cohort, median percent of time in the targeted therapeutic international normalized ratio range was 47.1% (range, 30.3-57.0%).

Recurrent VTE or major bleeding (primary endpoint) occurred in less patients in the DOAC cohort (6.5%) compared with the warfarin group (23.9%; P=0.045). There was a trend toward less recurrent VTE in those treated with a DOAC versus warfarin (6.5% vs. 21.7%; P=0.07).

Clinically relevant non-major bleeding (CRNMB; secondary endpoint) was similar between the treatment groups: 12.5% with DOACs versus 8.7% with warfarin (P=0.71). Among those receiving a DOAC, CRNMB occurred more commonly in those receiving rivaroxaban (18.2% vs. 0%; P=0.71). One patient in the warfarin cohort had an intracerebral hemorrhage.